24(b)(4)(a)(i)
XXXX XXXXXXX LIFE INSURANCE
COMPANY OF NEW YORK (XXXX XXXXXXX(R) LOGO)
ANNUITY SERVICE OFFICE
HOME OFFICE [P.O. Box 55230
[000 Xxxxxx Xxxx Xxxxx, 0xx Xxxxx Xxxxxx, XX 00000-0000
Xxxxxxxx, XX 00000] 0-000-000-0000]
THIS IS A LEGAL CONTRACT - READ IT CAREFULLY.
WE AGREE to pay the benefits of this Contract in accordance with its terms.
THIS CONTRACT is issued in consideration of the Payments.
TEN DAY RIGHT TO REVIEW
The Owner may cancel the Contract by returning it to our Annuity Service Office
or agent at any time within 10 days after receipt of the Contract. Within 7 days
of delivery of the Contract to us, we will pay to the Owner an amount equal to
the sum of (i) and (ii), where (i) is the difference between the payments made,
including any fees and deductions, and the amounts, if any, allocated to the
Separate Account under the Contract, (ii) is the Contract Value attributable to
the amounts, if any, allocated to the separate account under the Contract. The
Contract Value will be computed at the end of the Valuation Period during which
the Contract is delivered to us.
When the Contract is issued as an individual retirement annuity, during the
first 7 days of this 10 day period, we will return the greater of (i) Contract
Value computed at the end of the Valuation Period during which the Contract is
received by us or (ii) sum of all Payments.
The smallest annual rate of investment return which is required to be earned on
the assets of the separate account so that the dollar amount of variable annuity
payments will not decrease is 4.72%. Explicit annual charges against the assets
of the separate account are as follows:
Contract Asset Fee Charge: Not greater than 1.65%
SIGNED FOR THE COMPANY at its Home Office, Valhalla, New York,
on the Contract Date.
DETAILS OF VARIABLE ACCOUNT PROVISIONS ON PAGE 6.1
DETAILS OF FIXED ACCOUNT PROVISIONS ON PAGE 7.1
/s/ Xxxxx X. Xxxxxxxxx /s/ Xxxxxxx Xxxxx
President Secretary
Flexible Payment Deferred Combination Fixed* and Variable Annuity
Non-Participating
ANNUITY PAYMENTS, DEATH BENEFITS, SURRENDER VALUES, AND OTHER CONTRACT VALUES
PROVIDED BY THIS CONTRACT, WHEN BASED ON THE INVESTMENT EXPERIENCE OF A SEPARATE
ACCOUNT, ARE VARIABLE, MAY INCREASE OR DECREASE IN ACCORDANCE WITH THE
FLUCTUATIONS IN THE NET INVESTMENT FACTOR, AS APPLICABLE, AND ARE NOT GUARANTEED
AS TO FIXED DOLLAR AMOUNT, UNLESS OTHERWISE SPECIFIED.
* FIXED ACCOUNT(S) MAY NOT BE AVAILABLE AT THIS TIME. PLEASE REVIEW AVAILABLE
INVESTMENT OPTIONS PAGE FOR DETAILS.
VENTURE.100-NY-REV.06 [SAMPLE]
INTRODUCTION
This is a flexible payment deferred combination fixed and variable annuity
contract. This Contract provides that prior to the Maturity Date, the Contract
Value will accumulate on either a fixed or variable basis or a combination of
both. After the Maturity Date, annuity payments may be either fixed or variable,
or a combination of fixed and variable.
The variable portion of the Contract will vary with the investment performance
of your Investment Account. The fixed portion of the Contract will accumulate
based on interest rates guaranteed by the Company for the period selected.
If you select annuity payments on a variable basis, the payment amount will vary
with the investment performance of the Variable Account.
You must allocate Payments among one or more Investment Options. The Investment
Options are identified on the Specifications Page.
TABLE OF CONTENTS PAGE
----------------- ----
SPECIFICATIONS PAGE S.1
PART 1 - DEFINITIONS 1.1
PART 2 - GENERAL PROVISIONS 2.1
PART 3 - OWNERSHIP 3.1
PART 4 - BENEFITS 4.1
PART 5 - PAYMENTS 5.1
PART 6 - VARIABLE ACCOUNT PROVISIONS 6.1
PART 7 - FIXED ACCOUNT PROVISIONS 7.1
PART 8 - ANNUITY PROVISIONS 8.1
PART 9 - TRANSFERS 9.1
PART 10 - WITHDRAWAL PROVISIONS 10.1
PART 11 - FEES AND DEDUCTIONS 11.1
PART 12 - LOAN PROVISIONS 12.1
PART 13 - PAYMENT OF CONTRACT BENEFITS 13.1
TABLE OF ANNUITY PAYMENT RATES T.1
VENTURE.100-NY-REV.06 [SAMPLE]
SPECIFICATIONS PAGE
TYPE OF CONTRACT: [QUALIFIED] MATURITY DATE: [07/25/2027]
CONTRACT DATE: [07/25/1997] CONTRACT NUMBER: [000000005]
INITIAL PAYMENT: [$3,500.00] GOVERNING LAW: NY
OWNER: [XXXX XXX] OWNER'S AGE [46]
CO-OWNER [_____] CO-OWNER'S AGE [_____]
ANNUITANT: [XXXX XXX] ANNUITANT'S AGE: [46]
CO-ANNUITANT: [_____] CO-ANNUITANT'S [_____]
AGE
ANNUITY OPTION: [Life 10-Year Certain]
PLAN Venture III
MINIMUM GUARANTEED INTEREST RATE [3.0%] per year
ON FIXED ACCOUNTS
ASSET FEES
[2.00% years 1-7
CONTRACT ASSET FEE 1.85% years 8+]
[RIDER ASSET FEE(S)] [RIDER FEE PERCENTAGE]
[Enhanced Death Benefit Marketing Name] [0.20%]
TOTAL ASSET FEE PERCENTAGE
(CONTRACT ASSET FEE PLUS RIDER FEE(S)):
[2.20% years 1-7
2.05% years 8+]
ANNUAL FEE [$30.00(1)]
[(1) Prior to the Maturity Date, when the Annual Administration
Fee is to be assessed, if the sum of all your Investment
Accounts exceeds $100,000, the Annual Administration Fee will
be waived.]
[OTHER FEES]
[RIDER] [RIDER FEE PERCENTAGE]
[Guaranteed Minimum Withdrawal Benefit [1.20%]
Marketing Name]
MINIMUM DEATH BENEFIT The sum of all Payments made, less any amount
deducted in connection with partial withdrawals.
For purposes of calculating the Minimum Death
Benefit, the amount deducted in connection with
partial withdrawals will be equal to (i) times
(ii), where (i) is equal to the Minimum Death
Benefit prior to the withdrawal, and (ii) is equal
to the partial withdrawal amount divided by the
Contract Value prior to the partial withdrawal.
VENTURE.100-NY-REV.06 [S.1] [SAMPLE]
PAYMENT LIMITS The initial Payment is shown above. Additional
Payments may be made at any time. However, each
additional Payment must be at least $30. If a
Payment would cause the Contract Value to exceed
$1,000,000, or the Contract Value already exceeds
$1,000,000, no additional Payments will be
accepted without our prior approval.
TRANSFER CHARGES AND We reserve the right to impose, upon notice, a
LIMITATIONS - BEFORE transaction charge for transfers. In the event a
MATURITY DATE charge is imposed, it will not exceed the lesser
of $25.00 or 2% of the amount of each transfer.
We reserve the right to limit, upon notice, the
amount of the transfer and the maximum number of
transfers that can be made.
You must transfer at least $300 or, if less, the
entire amount in the Investment Account each time
you make a transfer. If, after the transfer, the
amount remaining in the Investment Account from
which the transfer is made is less than $100, then
we will transfer the entire amount instead of the
requested amount.
Should we limit the maximum number of transfers
that can be made per Contract Year, that limit
will be no less than one per month or six at any
time within a Contract Year
TRANSFER CHARGES AND We reserve the right to limit, upon notice, the
LIMITATIONS -- ON OR maximum number of transfers you may make per
AFTER MATURITY DATE Contract Year after variable annuity payments have
begun.
If we limit the maximum number of transfers that
can be made after variable annuity payments have
begun, the maximum number of transfers you may
make per Contract Year shall be no less than 4.
LIMITATIONS ON AMOUNT OF Any withdrawal from an Investment Account must be
PARTIAL WITHDRAWALS at least $300 or the entire balance of the
Investment Account, if less. If after the
withdrawal, the amount remaining in that
Investment Account is less than $100, then we will
consider the withdrawal request to be a request
for withdrawal of the entire amount held in the
Investment Account. If a partial withdrawal would
reduce the Contract Value to less than $300, or if
the amount requested is greater than or equal to
the amount available as a total withdrawal, then
we will treat the partial withdrawal request as a
total withdrawal of the Contract Value.
TABLE OF WITHDRAWAL Number of Complete Years Withdrawal Charge
CHARGES Payment has been in Contract Percentage
---------------------------- -----------------
0 7%
1 6
2 5
3 4
4 3
5+ 0
Withdrawal charges are applied to liquidated
purchase payments. Purchase payments are
liquidated when the amount of a withdrawal during
a Contract Year exceeds the free withdrawal amount
for that year. The amount of the payments
liquidated equals the amount of the withdrawal in
excess of the free withdrawal amount. A total
withdrawal liquidates all unliquidated purchase
payments.
VENTURE.100-NY-REV.06 [S.2] [SAMPLE]
FREE WITHDRAWAL AMOUNT The Free Withdrawal Amount is defined as the
greater of:
(a) the excess of the Contract Value on the
date of withdrawal over the unliquidated
Payments, or
(b) the excess of (i) over (ii), where:
(i) equals 10% times the total Payments;
and
(ii) equals 100% of all prior partial
withdrawals, in that Contract Year.
VENTURE.100-NY-REV.06 [S.3] [SAMPLE]
SPECIFICATIONS PAGE (CONTINUED)
[ENHANCED DEATH BENEFIT RIDER MARKETING NAME]
[RIDER DATE:] [07/25/1997]
[RIDER FEE PERCENTAGE:] [0.20%]
[GUARANTEED MINIMUM WITHDRAWAL BENEFIT RIDER
MARKETING NAME:]
[RIDER DATE] [07/25/1997]
[RIDER FEE PERCENTAGE] [1.20%]
OWNER: [XXXX XXX] OWNER'S AGE [46]
CO-OWNER [_____] CO-OWNER'S AGE [_____]
ANNUITANT: [XXXX XXX] ANNUITANT'S AGE: [46]
CO-ANNUITANT: [_____] CO-ANNUITANT'S AGE [_____]
BENEFICIAIRY SEE ATTACHED LIST
VENTURE.100-NY-REV.06 [S.4] [SAMPLE]
INITIAL ALLOCATION OF NET PAYMENT: (SEE REVERSE FOR ALL AVAILABLE OPTIONS)
INITIAL INITIAL GUARANTEE
FIXED INVESTMENT OPTIONS: INTEREST RATE PERIOD EXPIRES
------------------------- ------------- -----------------
[6 MONTH DCA] [25.00%] [3.00%] [01/25/1998]
[ONE YEAR FIXED] [00.00%] [3.00%] [07/25/1998]
[12 MONTH DCA] [00.00%] [3.00%] [07/25/1998]
THE INTEREST RATE FOR THE 6 [OR 12] MONTH DCA FIXED ACCOUNT OPTION MAY CONTAIN
AN ENHANCEMENT THAT MAY NOT BE PROVIDED IN SUBSEQUENT GUARANTEE PERIODS [OR IN
THE ONE YEAR FIXED ACCOUNT]
VARIABLE INVESTMENT OPTIONS:
[MID CAP CORE] [75.00%]
TOTAL 100.00%
[THIS PLAN IS INTENDED TO QUALIFY UNDER THE INTERNAL REVENUE CODE FOR
TAX-FAVORED STATUS. LANGUAGE CONTAINED IN THIS CONTRACT REFERRING TO FEDERAL TAX
STATUS OR RULES IS INFORMATIONAL AND INSTRUCTIONAL. PLEASE SEEK THE ADVICE OF
YOUR OWN TAX ADVISOR REGARDING YOUR INDIVIDUAL TAX TREATMENT.]
VENTURE.100-NY-REV.06 [S.5] [SAMPLE]
AVAILABLE INVESTMENT OPTIONS
[FIXED INVESTMENT OPTIONS]
6 Month DCA
One Year
1 Year Fixed Not Currently Available
NO1YRFXD03
12 Month DCA
12 Month DCA Not Currently Available
NO12MODCA03
[VARIABLE INVESTMENT OPTIONS]
[Science & Technology] [Income & Value]
[Pacific Rim Emerging Markets] [Global Allocation]
[Health Sciences] [High Yield]
[Small Cap Growth] [Global Bond]
[Mid Cap Stock] [Investment Quality Bond]
[Natural Resources] [Total Return]
[Financial Services] [American Bond]
[International Opportunities] [U.S. Government Securities]
[International Small Cap] [Money Market]
[AF International]
[International Value] LIFESTYLE PORTFOLIOS:
[International Stock] [Aggressive]
[Mid Cap Core] [Growth]
[Cap App] [Balanced]
[AF Growth Fund] [Moderate]
[Blue Chip Growth] [Conservative]
[U.S. Large Cap]
[Core Equity] INDEX PORTFOLIOS:
[Classic Value] [SMALL CAP]
[Real Estate Securities] [International]
[Small Cap Opportunities] [Mid Cap]
[Small Company Value] [Total Stock Market]
[Value] [500]
[Fundamental Value] [Index Allocation]
[AF Growth-Income]
[Equity-Income]
VENTURE.100-NY-REV.06 [S.6] [SAMPLE]
BENEFICIARY INFORMATION
[Play Dough]
VENTURE.100-NY-REV.06 [S.7] [SAMPLE]
PART 1 DEFINITIONS
------ --------------------------------------------------
WE AND YOU "We", "us" and "our" means Xxxx Xxxxxxx Life
Insurance Company of New York. "You" or "your"
means the Owner of this Contract.
ACCUMULATION UNIT A unit of measure that is used to calculate the
value of the variable portion of this Contract
before the Maturity Date.
ANNUITANT Any individual person or persons whose life is
used to determine the duration of annuity payments
involving life contingencies. The Annuitant is as
designated on the Specifications Page, unless
changed.
ANNUITY OPTION The method selected by you for annuity payments
made by us.
ANNUITY SERVICE OFFICE Any office designated by us for the receipt of
Payments and processing of Owner requests.
ANNUITY UNIT A unit of measure that is used after the Maturity
Date to calculate Variable Annuity payments.
BENEFICIARY The person, persons or entity to whom certain
benefits are payable following the death of an
Owner, or in certain circumstances, an Annuitant.
CONTRACT ANNIVERSARY The anniversary of the Contract Date.
CONTRACT DATE The date of issue of this Contract as designated
on the Specifications Page.
CONTRACT VALUE The total of your Investment Account Values and,
if applicable, any amount in the Loan Account
attributable to your Contract.
CONTRACT YEAR The period of twelve consecutive months beginning
on the Contract Date or any anniversary
thereafter.
CONTINGENT BENEFICIARY The person, persons or entity who becomes entitled
to receive the Contract proceeds if all
Beneficiaries die before the annuitant dies.
DEBT Any amounts in the Loan Account attributable to
your Contract plus any accrued loan interest on
that amount. The loan provision is only available
to certain Qualified Contracts.
DESIGNATED BENEFICIARY For purposes of section 72(s) if the Internal
Revenue Code, the "designated beneficiary" under
the contract shall be the individual who is
entitled to receive the amounts payable on death
of an Owner, or if any Owner is not an individual,
on any change in, or death of, an Annuitant.
ENDORSEMENT An Endorsement modifies the contract to which it
is attached. Endorsements must be signed by an
officer of the Company in order to be effective.
FIXED ANNUITY An Annuity Option with payments which are
predetermined and guaranteed as to dollar amount.
GENERAL ACCOUNT All the assets of Xxxx Xxxxxxx Life Insurance
Company of New York other than assets in separate
accounts.
INTERNAL REVENUE CODE (IRC) The Internal Revenue Code of 1986, as amended from
time to time, and any successor statute of similar
purposes.
INVESTMENT ACCOUNT An account established by us which represents your
interest in an Investment Option prior to the
Maturity Date.
INVESTMENT ACCOUNT VALUE The value of your investment in an Investment
Account.
VENTURE.100-NY-REV.06 [SAMPLE]
1.1
INVESTMENT OPTIONS The Investment Options can be either fixed or
variable. The Investment Options available under
this Contract are shown on the Specifications
Page.
LOAN ACCOUNT The portion of the General Account that is used
for collateral when a loan is taken.
MATURITY DATE The date on which annuity benefits commence. It is
the date specified on the Specifications Page,
unless changed.
NET PAYMENT The Payment less the amount of premium tax, if
any, deducted from the Payment.
NON-QUALIFIED CONTRACTS Contracts which are not issued under Qualified
Plans.
OWNER The person, persons or entity entitled to the
ownership rights under this Contract. The Owner is
as designated on the Specifications Page, unless
changed.
PORTFOLIO OR TRUST A separate portfolio of Xxxx Xxxxxxx Investment
PORTFOLIO Trust, a mutual fund in which the Variable Account
invests, or a portfolio of any other mutual fund
in which the Variable Account invests.
PAYMENT An amount paid to us by you as consideration for
the benefits provided by this Contract.
RIDER A rider provides an optional benefit, which may
result in an additional charge to the Contract. A
rider supplements the contract to which it is
attached. Riders must be signed by an officer of
the Company in order to be effective.
QUALIFIED CONTRACTS Contracts issued under Qualified Plans.
QUALIFIED PLANS Retirement plans which receive favorable tax
treatment under sections 401, 403, 408 or 457, of
the Internal Revenue Code of 1986, as amended.
SEPARATE ACCOUNT A segregated account of Xxxx Xxxxxxx Life
Insurance Company of New York that is not
commingled with our general assets and
obligations.
SUB-ACCOUNT(S) One or more of the Sub-Accounts of the Variable
Account. Each Sub-Account is invested in shares of
a different Trust Portfolio.
VALUATION DATE Any date on which the New York Stock Exchange is
open for business and the net asset value of a
Trust Portfolio is determined.
VALUATION PERIOD Any period from one Valuation Date to the next,
measured from the time on each such date that the
net asset value of each Portfolio is determined.
VARIABLE ACCOUNT Xxxx Xxxxxxx Life Insurance Company of New York
Separate Account A.
VARIABLE ANNUITY An Annuity Option with payments which: (1) are not
predetermined or guaranteed as to dollar amount;
and (2) vary in relation to the investment
experience of one or more specified variable
Sub-Accounts.
VENTURE.100-NY-REV.06 [SAMPLE]
1.2
PART 2 GENERAL PROVISIONS
------ --------------------------------------------------
ENTIRE CONTRACT The entire Contract consists of this Contract,
Endorsements and Riders, if any, and the
application, if one is attached to this Contract.
Only the President, a Vice President, or the
Secretary of the Company has authority to agree on
our behalf to any alteration of the Contract or to
any waiver of our rights or requirements. The
change or waiver must be in writing.
The benefits and values available under this
Contract are not less than the minimum required by
any statute of the state in which this Contract is
delivered. We have filed a detailed statement of
the method used to calculate the benefits and
values with the Department of Insurance in the
state in which this Contract is delivered, if
required by law.
MODIFICATION We will not change or modify this Contract without
your consent except as may be required to make it
conform to any applicable law or regulation or any
ruling issued by a government agency.
BENEFICIARY The Beneficiary is as designated on the
Specifications Page, unless changed. However, if
there is a surviving Owner, that person will be
treated as the Beneficiary. If no such Beneficiary
is living, the Beneficiary is the "Contingent
Beneficiary". If no Beneficiary or Contingent
Beneficiary is living, the Beneficiary is the
estate of the deceased Owner.
CHANGE IN MATURITY DATE Prior to the Maturity Date, you may change the
Maturity Date by written request at least one
month before both the previously specified
Maturity Date and the new Maturity Date. Once
elected, the new Maturity Date will become the
Maturity Date. The maximum Maturity Date will be
age 90. Any extension of the Maturity Date will be
subject to our prior approval.
ASSIGNMENT You may assign this Contract at any time prior to
the Maturity Date. No assignment will be binding
on us unless it is written in a form acceptable to
us and received at our Annuity Service Office. We
will not be liable for any payments made or
actions we take before the assignment is accepted
by us. An absolute assignment will revoke the
interest of any revocable Beneficiary. We will not
be responsible for the validity of any assignment.
CLAIMS OF CREDITORS To the extent permitted by law, no benefits
payable under this Contract will be subject to the
claims of your, the Beneficiary's, or the
Annuitant's creditors.
MISSTATEMENT AND PROOF OF We may require proof of age, sex or survival of
AGE, SEX OR SURVIVAL any person upon whose age, sex or survival any
payments depend. If the age or sex of the
Annuitant has been misstated, the benefits will be
those which the Payments would have provided for
the correct age and sex. If we have made incorrect
annuity payments, the amount of any underpayment,
adjusted with interest at 3% per annum, will be
paid immediately. The amount of any overpayment
will be deducted from future annuity payments
without adjustment for interest.
VENTURE.100-NY-REV.06 [SAMPLE]
2.1
ADDITION, DELETION OR We reserve the right, subject to prior approval of
SUBSTITUTION OF INVESTMENT the New York Superintendent of Insurance and in
OPTIONS compliance with applicable law, to make additions
to, deletions from, or substitutions for the
Portfolio shares that are held by the Variable
Account or that the Variable Account may purchase.
We reserve the right to eliminate the shares of
any of the eligible Portfolios and to substitute
shares of another Portfolio of the Trust, or of
another open-end registered investment company, if
the shares of any eligible Portfolio are no longer
available for investment, or if in our judgment
further investment in any eligible Portfolio
should become inappropriate in view of the
purposes of the Variable Account. We will not
substitute any shares attributable to your
interest in a Sub-Account without notice to you
and prior approval of the Securities and Exchange
Commission to the extent required by the
Investment Company Act of 1940. Nothing contained
herein shall prevent the Variable Account from
purchasing other securities for other series or
classes of contracts, or from effecting a
conversion between shares of another open-end
investment company.
We reserve the right, subject to prior approval of
the New York Superintendent of Insurance and in
compliance with applicable law, to establish
additional Sub-Accounts which would invest in
shares of a new Portfolio of the Trust or in
shares of another open-end investment company. We
also reserve the right to eliminate existing
Sub-Accounts, to combine Sub-Accounts or to
transfer assets in a Sub-Account to another
Separate Account established by us or an
affiliated company. In the event of any such
substitution or change, we may, by appropriate
endorsement, make such changes in this and other
Contracts as may be necessary or appropriate to
reflect such substitutions or change. If deemed by
us to be in the best interests of persons having
voting rights under the Contracts, the Variable
Account may be operated as a management company
under the Investment Company Act of 1940 or it may
be de-registered under such Act in the event such
registration is no longer required.
NON-PARTICIPATING Your Contract is non-participating and will not
share in our profits or surplus earnings. We will
pay no dividends on your Contract.
REPORTS We will send you reports containing information
required by the Investment Company Act of 1940 and
applicable state law in the time periods required
by such laws.
INSULATION The portion of the assets of the Variable Account
equal to the reserves and other contract
liabilities with respect to such account are not
chargeable with liabilities arising out of any
other business we may conduct. Moreover, the
income, gains and losses, realized or unrealized,
from assets allocated to the Variable Account
shall be credited to or charged against such
account without regard to our other income, gains
or losses.
SEPARATE ACCOUNT ASSETS We will maintain, in the Separate Account, assets
with a value at least equal to the amounts
accumulated in accordance with the terms of the
applicable agreements with respect to the Separate
Account, and the reserves for annuities, in the
course of payment that vary with the investment
experience of the Separate Account.
CURRENCY AND PLACE OF All payments made to or by us shall be made in the
PAYMENTS lawful currency of the United States of America at
the Annuity Service Office or elsewhere if we
consent.
NOTICES AND ELECTIONS To be effective, all notices and elections you
make under this Contract must be in writing,
signed by you and received by us at the Annuity
Service Office. Unless otherwise provided in this
Contract, all notices, requests and elections will
be effective when received by us at our Annuity
Service Office, complete with all necessary
information and your signature.
GOVERNING LAW This Contract will be governed by the laws of the
jurisdiction indicated on the Specifications Page.
VENTURE.100-NY-REV.06 [SAMPLE]
2.2
SECTION 72(S) The provisions of this Contract shall be
interpreted so as to comply with the requirements
of Section 72(s) of the Internal Revenue Code.
VENTURE.100-NY-REV.06 [SAMPLE]
2.3
PART 3 OWNERSHIP
------ ---------
GENERAL Before the Maturity Date, the Owner of this
Contract shall be the person, persons or entity
designated on the Specifications Page or the
latest change filed with us. On the Maturity Date
the Annuitant becomes the Owner of this Contract.
If amounts become payable to the Beneficiary under
this Contract, the Beneficiary becomes the Owner
of this Contract.
CHANGE OF OWNER, ANNUITANT, Subject to the rights of an irrevocable
BENEFICIARY Beneficiary, you may change the Owner, Annuitant,
or Beneficiary by written request in a form
acceptable to us and which is received at our
Annuity Service Office. The Annuitant may not be
changed after the Maturity Date. You need not send
us the Contract unless we request it. Any change
must be approved by us. If approved, any change of
Owner, Annuitant, or Beneficiary will take effect
on the date the request is signed. We will not be
liable for any payments or actions we take before
the change is approved.
The substitution or addition of any Owner may
result in the resetting of the Death Benefit to an
amount equal to the Contract Value as of the date
of such change. For purposes of subsequent
calculations of the Death Benefit, described in
Part 4, Benefits, Death Benefit Before Maturity
Date, the Contract Value on the date of the change
will be treated as a Payment made on that date. In
addition, all anniversary values, all Payments
made and all amounts deducted in connection with
partial withdrawals prior to the date of the
change of Owner will not be considered in the
determination of the Death Benefit. This paragraph
will not apply if (a) the individual whose death
will cause the Death Benefit to be paid is the
same after the change of Owner, or (b) if
Ownership is transferred to the Owner's spouse.
If any Annuitant is changed and any Owner is not
an individual, the entire interest in the Contract
must be distributed to the Owner within five years
of the change.
VENTURE.100-NY-REV.06 [SAMPLE]
3.1
PART 4 BENEFITS
------ --------
ANNUITY BENEFITS We will pay a monthly income to the Annuitant, if
living, on the Maturity Date. Payments can be
fixed or variable, or a combination of fixed and
variable. Annuity benefits will commence on the
Maturity Date and continue for the period of time
provided for under the Annuity Option indicated on
the Specifications Page. On or before to the
Maturity Date, you may change the Annuity Option.
You may select a Fixed or Variable Annuity. Unless
you indicate otherwise, we will provide either
variable or fixed, or a combination variable and
fixed annuity payments in proportion to the
Investment Account Value of each Investment Option
at the Maturity Date. Once annuity payments
commence, the Annuity Option may not be changed.
The method used to calculate the amount of the
initial and subsequent payments is described under
the Part 8, Annuity Provisions, of this Contract.
We may pay the Contract Value, less Debt, on the
Maturity Date in one lump sum if the monthly
income is less than $20.
DEATH BENEFIT BEFORE A Death Benefit will be determined as of the date
MATURITY DATE on which written notice and proof of death and all
required claim forms are received at the Company's
Annuity Service Office as follows:
The Death Benefit will be determined as the
greater of the Contract Value or the Minimum Death
Benefit described on the Specifications Page.
If there is any Debt, the Death Benefit equals the
amount described above less the Debt under the
Contract.
We will permit the Owner to limit the Death
Benefit option(s) to be offered any named
Beneficiary, if the Owner provides written notice
to the Company prior to death and the desired
option(s) is one provided for in this Contract.
DEATH OF ANNUITANT: On the death of the last
surviving Annuitant, the Owner becomes the new
Annuitant, if the Owner is an individual. If any
Owner is not an individual the death of any
Annuitant is treated as the death of an Owner and
the Death Benefit will be determined by
substituting the Annuitant for the Owner as
described below.
DEATH OF OWNER: We will pay the Death Benefit to
the Beneficiary if any Owner dies prior to the
Maturity Date. The Death Benefit may be taken in
one sum immediately, in which case the Contract
will terminate. If the Death Benefit is not taken
in one sum immediately, the Contract will continue
subject to the following provisions:
(a) The Beneficiary becomes the Owner.
(b) The excess, if any, of the Death Benefit over
the Contract Value will be allocated to and
among the Investment Accounts in proportion
to their values as of the date on which the
Death Benefit is determined.
(c) No additional Payments may be applied to the
Contract.
(d) If the Beneficiary is not the deceased
Owner's spouse, the entire interest in the
Contract must be distributed under one of the
following options:
VENTURE.100-NY-REV.06 [SAMPLE]
4.1
(i) The entire interest in the Contract must
be distributed over the life of the
Beneficiary, or over a period not
extending beyond the life expectancy of
the Beneficiary, with distributions
beginning within one year of the Owner's
death; or
(ii) the entire interest in the Contract must
be distributed within 5 years of the
Owner's Death.
If the Beneficiary dies before the
distributions required by (i) or (ii) are
complete, the entire remaining Contract Value
must be distributed in a lump sum
immediately.
e) If the Beneficiary is the deceased Owner's
spouse, the Contract will continue with the
surviving spouse as the new Owner. The
surviving spouse may name a new Beneficiary
(and, if no Beneficiary is so named, the
surviving spouse's estate will be the
Beneficiary).
(f) Withdrawal Charges will be waived on any
withdrawals.
If there is more than one Beneficiary, the
foregoing provisions will independently apply to
each Beneficiary, to the extent of that
Beneficiary's share.
DEATH BENEFIT ON OR AFTER If annuity payments have been selected based on an
MATURITY DATE Annuity Option providing for payments for a
guaranteed period, and the Annuitant dies on or
after the Maturity Date, we will make the
remaining guaranteed payments to the Beneficiary.
Any remaining payments will be made as rapidly as
under the method of distribution being used as of
the date of the Annuitant's death. If no
Beneficiary is living, we will commute any unpaid
guaranteed payments to a single sum (on the basis
of the interest rate used in determining the
payments) and pay that single sum to the estate of
the last to die of the Annuitant and the
Beneficiary.
PROOF OF DEATH Proof of death is required upon the death of the
Annuitant or the Owner. Proof of death is one of
the following received at the Annuity Service
Office:
(a) A certified copy of a death certificate.
(b) A certified copy of a decree of a court of
competent jurisdiction as to the finding of
death.
(c) Any other proof satisfactory to us.
VENTURE.100-NY-REV.06 [SAMPLE]
4.2
PART 5 PAYMENTS
------ --------
GENERAL All Payments under this Contract are payable at
our Annuity Service Office or such other place as
we may designate. Payment Limits are identified on
the Specifications Page.
NONPAYMENT OF PAYMENTS FOR If, prior to the Maturity Date, no Payments have
THREE YEARS been made for three consecutive Contract Years,
and if both:
(a) the total Payments made, less any partial
withdrawals, are less then $2,000; and
(b) the Contract Value at the end of such three
year period is less than $2,000;
We may cancel this Contract and pay you the
Contract Value (measured as of the Valuation
Period during which the cancellation occurs), less
the Debt and Annual Administration Fee. We will
provide you with 31 days prior written notice
before canceling the Contract.
ALLOCATION OF NET PAYMENTS When we receive Payments, the Net Payments will be
allocated among Investment Options in accordance
with the allocation percentages shown on the
Specifications Page. You may change the allocation
of subsequent Net Payments at any time, without
charge, by giving us written notice in a form
acceptable to us.
VENTURE.100-NY-REV.06 [SAMPLE]
5.1
PART 6 VARIABLE ACCOUNT PROVISIONS
------ ---------------------------
INVESTMENT ACCOUNT We will establish a separate Investment Account
for you for each variable Investment Option to
which you allocate amounts. The Investment Account
represents the number of your Accumulation Units
in an Investment Option.
INVESTMENT ACCOUNT VALUE The Investment Account Value of an Investment
Account is determined by (a) times (b) where:
(a) equals the number of Accumulation Units
credited to the Investment Account; and,
(b) equals the value of the appropriate
Accumulation Unit.
ACCUMULATION UNITS We will credit Net Payments to your Investment
Accounts in the form of Accumulation Units. The
number of Accumulation Units to be credited to
each Investment Account of the Contract will be
determined by dividing the Net Payment allocated
to that Investment Account by the Accumulation
Unit value for that Investment Account.
Accumulation Units will be adjusted for any
transfers and will be canceled on payment of a
death benefit, withdrawal, maturity or assessment
of certain charges based on their value for the
Valuation Period in which such transaction occurs.
VALUE OF ACCUMULATION UNIT The Accumulation Unit value for a particular
Investment Account for any Valuation Period is
determined by multiplying the Accumulation Unit
value for the immediately preceding Valuation
Period by the "net investment factor" for the
Valuation Period for which the value is being
determined. The value of an Accumulation Unit may
increase, decrease or remain the same from one
Valuation Period to the next.
NET INVESTMENT FACTOR The net investment factor is an index that
measures the investment performance of a
Sub-Account from one Valuation Period to the next.
The net investment factor for any Valuation Period
is determined by dividing (a) by (b) and
subtracting (c) from the result where:
(a) is the net result of:
1) the net asset value per share of a
Portfolio share held in the Sub-Account
determined as of the end of the current
Valuation Period, plus:
2) the per share amount of any dividend or
capital gain distributions made by the
Portfolio on shares held in the
Sub-Account if the "ex-dividend" date
occurs during the current Valuation
Period, and
(b) is the net asset value per share of a
Portfolio share held in the Sub-Account
determined as of the end of the immediately
preceding Valuation Period, and
(c) is the Asset Fee shown on the Specifications
Page.
The net investment factor may be greater or less
than, or equal to, one.
VENTURE.100-NY-REV.06 6.1 [SAMPLE]
PART 7 FIXED ACCOUNT PROVISIONS
------ ------------------------
INVESTMENT ACCOUNT We will establish a separate Investment Account
for you each time you allocate amounts to a fixed
Investment Option. Amounts invested in these
Investment Accounts will earn interest at the
guaranteed rate in effect on the date the amounts
are allocated for the duration of the guarantee
period.
We will determine the guaranteed rates from time
to time for Net Payments, renewal amounts and
amounts transferred to a fixed Investment Option.
In no event will the rate be less than the Minimum
Guaranteed Interest Rate on Fixed Accounts as
specified in the Specifications Page.
We reserve the right to prohibit or restrict
Payments and transfers to the fixed Investment
Option(s) if the effective annual rate of interest
that would apply to the Payment or transfer is
equal to the Minimum Guaranteed Interest Rate on
Fixed Accounts, as specified on the Specifications
Page.
If such restrictions on Payments or Transfers are
not in effect on the Contract Date, we will
provide at least 30 days prior written notice of
any restrictions on Payments and transfers after
the Contract Date. Prior written notice will
specify the fixed Investment Option(s) that are
affected by such restriction.
Any such restriction on Payments or Transfers to
the fixed Investment Option(s) will not apply to
automatic renewals of amounts already allocated to
a fixed Investment Option(s). Renewal amount(s)
are otherwise subject to the terms and conditions
described in the Renewal provisions of the
Contract.
We will provide notice in writing within 30 days
of when restrictions on Payments or transfers to
fixed Investment Option(s) are removed.
GUARANTEE PERIODS For any amounts allocated to the fixed Investment
Options, you have the choice of the guarantee
periods available as shown on the Specifications
Page. The amount can be allocated into any
combination of the fixed Investment Options
offered under this Contract.
Separate Investment Accounts will be established
for each guarantee period. The guarantee period
will be the duration of the fixed Investment
Option selected measured from the date the amount
is allocated to the Investment Account. Amounts
cannot be allocated to a fixed Investment Option
that would extend the guarantee period beyond the
Maturity Date.
RENEWALS The renewal amount is the Investment Account Value
at the end of the particular guarantee period. The
renewal amount will be automatically renewed in
the same Investment Option at the end of the
guarantee period, unless you specify otherwise. If
renewal in a particular Investment Option would
result in the guarantee period for that Investment
Account extending beyond the Maturity Date, the
renewal amount may not be renewed in that
Investment Option. The renewal amount will be
applied to the longest guarantee period of a fixed
Investment Option such that the guarantee period
does not extend beyond the Maturity Date.
DOLLAR COST AVERAGING (DCA) The DCA Investment Option may be elected by the
Owner to make automatic monthly transfers from a
fixed Investment Account to one or more variable
Investment Options. Only initial and subsequent
Net Payments may be allocated to the DCA
Investment Option. Amounts may not be transferred
from other Investment Options to the DCA
Investment Option.
VENTURE.100-NY-REV.06 7.1 [SAMPLE]
INVESTMENT ACCOUNT VALUE The amount in the fixed Investment Accounts will
accumulate at a rate of interest determined by us
and in effect on the date the amount is allocated
to the Investment Account. The Investment Account
Value is the accumulated value of the amount
invested in the Investment Account reduced by any
withdrawals, loans, transfers or charges taken
from the Investment Account. In no event will the
sum of the Investment Account Values for all fixed
Investment Options be less than the Minimum
Investment Account Value.
MINIMUM INVESTMENT ACCOUNT
VALUE The Minimum Investment Account Value is the sum of
the amounts allocated to all fixed Investment
Accounts reduced by any withdrawals, loans,
transfers or charges taken from all fixed
Investment Accounts, accumulated at the Minimum
Guaranteed Interest Rate on Fixed Accounts, as
specified on the Specifications Page.
VENTURE.100-NY-REV.06 7.2 [SAMPLE]
PART 8 ANNUITY PROVISIONS
------ ------------------
VARIABLE ANNUITY PAYMENTS The amount of the first Variable Annuity payment
is determined by applying the portion of the
Contract Value used to effect a Variable Annuity
(minus any applicable premium taxes) to the
appropriate table(s) contained in this Contract.
If the table in use by us on the Maturity Date is
more favorable to you, we will use that table. The
portion of the Contract Value used to effect a
Variable Annuity will be measured as of a date not
more than 10 business days prior to the Maturity
Date.
Subsequent payments will be based on the
investment performance of one or more Sub-Accounts
as you select. The amount of such payments is
determined by the number of Annuity Units credited
for each Sub-Account. Such number is determined by
dividing the portion of the first payment
allocated to that Sub-Account by the Annuity Unit
value for that Sub-Account determined as of the
same date that the Contract Value used to effect
annuity payments was determined. This number of
Annuity Units for each Sub-Account is then
multiplied by the appropriate Annuity Unit value
for each subsequent determination date, which is a
uniformly applied date not more than 10 business
days before the payment is due.
Variable Annuity payments, at the time of their
commencement, will not be less than those that
would be provided by the application of an amount
to purchase any single consideration immediate
annuity contract, offered at the time, to the same
class of annuitants. Since no such annuity
contract currently exists, a comparable contract
in an affiliated company will be used. Such an
amount would be equal to the greater of:
(a) the Contract Value less applicable Withdrawal
Charges; or
(b) 95% of the Contract Value.
MORTALITY AND EXPENSE We guarantee that the dollar amount of each
GUARANTEE variable annuity payment will not be affected by
changes in mortality and expense experience.
ANNUITY UNIT VALUE The value of an Annuity Unit for each Sub-Account
for any Valuation Period is determined as follows:
(a) The net investment factor for the Sub-Account
for the Valuation Period for which the
Annuity Unit value is being calculated is
multiplied by the value of the Annuity Unit
for the preceding Valuation Period; and
(b) The result is adjusted to compensate for the
interest rate assumed in the tables used to
determine the first Variable Annuity payment.
The dollar value of Annuity Units may increase,
decrease or remain the same from one Valuation
Period to the next.
VENTURE.100-NY-REV.06 [SAMPLE]
8.1
FIXED ANNUITY PAYMENTS The amount of each Fixed Annuity payment is
determined by applying the portion of the Contract
Value used to effect a Fixed Annuity measured as
of a date not more than 10 business days prior to
the Maturity Date (minus any applicable premium
taxes) to the appropriate table(s) contained in
the Contract. If the table in use by us on the
Maturity Date is more favorable to the Owner, we
will use that table.
Fixed Annuity payments, at the time of their
commencement, will not be less than those that
would be provided by the application of an amount
to purchase any single consideration immediate
annuity contract, offered at the time, to the same
class of annuitants. Since no such annuity
contract currently exists, a comparable contract
in an affiliated company will be used. Such an
amount would be equal to the greater of:
(a) the Contract Value less applicable Withdrawal
Charges; or
(b) 95% of the Contract Value.
We guarantee the dollar amount of Fixed Annuity
payments.
VENTURE.100-NY-REV.06 [SAMPLE]
8.2
PART 9 TRANSFERS
------ ---------
TRANSFERS BEFORE MATURITY Before the Maturity Date, you may transfer amounts
DATE among Investment Accounts of the Contract. Amounts
will be canceled from the Investment Accounts from
which amounts are transferred and credited to the
Investment Account to which amounts are
transferred. We will effect such transfers so that
the Contract Value on the date of transfer will
not be affected by the transfer.
We reserve the right to defer, modify or terminate
the transfer privilege at any time. Other transfer
charges and limitations are identified on the
Specifications Page.
Amounts may not be transferred from a fixed
Investment Account unless those amounts have been
in the fixed Investment Account for at least one
year.
We reserve the right to prohibit or restrict
Payments and transfers to the fixed Investment
Option(s) if the effective annual rate of interest
that would apply to the Payment or transfer is
equal to the Minimum Guaranteed Interest Rate on
Fixed Accounts, as specified on the Specifications
Page.
If such restrictions on Payments or Transfers are
not in effect on the Contract Date, we will
provide at least 30 days prior written notice of
any restrictions on Payments and transfers after
the Contract Date. Prior written notice will
specify the fixed Investment Option(s) that are
affected by such restriction.
Any such restriction on Payments or Transfers to
the fixed Investment Option(s) will not apply to
automatic renewals of amounts already allocated to
a fixed Investment Option(s). Renewal amount(s)
are otherwise subject to the terms and conditions
described in the Renewal provisions of the
Contract.
We will provide notice in writing within 30 days
of when restrictions on Payments or transfers to
fixed Investment Option(s) are removed.
TRANSFERS ON OR AFTER Once variable annuity payments have begun, you may
MATURITY DATE transfer all or part of the investment upon which
your variable annuity payments are based from one
Sub-Account to another. To do this, we will
convert the number of variable Annuity Units you
hold in the Sub-Account from which you are
transferring to a number of variable Annuity Units
of the Sub-Account to which you are transferring
so that the next annuity payment, if it were made
at that time, would be the same amount that it
would have been without the transfer. After the
transfer, the variable annuity payments will
reflect changes in the values of your new variable
Annuity Units. You must give us notice at least 30
days before the due date of the first variable
annuity payment to which the transfer will apply.
We reserve the right to defer, modify or terminate
the transfer privilege at any time. Other transfer
charges and limitations are identified on the
Specifications Page.
After the Maturity Date, transfers will not be
allowed from a fixed to a variable Annuity Option,
or from a variable to a fixed Annuity Option.
VENTURE.100-NY-REV.06 [SAMPLE]
9.1
PART 10 WITHDRAWAL PROVISIONS
------- ---------------------
CONTRACT VALUE Your Contract Value is equal to the total of your
Investment Account Values and, if applicable, any
amount in the Loan Account attributable to the
Contract.
PAYMENTS OF WITHDRAWALS You may withdraw part or all of the Contract
Value, less any Debt, at any time before the
earlier of the death of an Owner or the Maturity
Date, by sending us a written request. We will pay
all withdrawals within seven days of receipt at
the Annuity Service Office subject to postponement
in certain circumstances, as specified below.
SUSPENSION OF PAYMENTS We may defer the right of withdrawal from, or
postpone the date of payments from, the variable
Investment Accounts for any period when: (1) the
New York Stock Exchange is closed (other than
customary weekend and holiday closings); (2)
trading on the New York Stock Exchange is
restricted; (3) an emergency exists as a result of
which disposal of securities held in the Variable
Account is not reasonably practicable or it is not
reasonably practicable to determine the value of
the Variable Account's net assets; or (4) the
Securities and Exchange Commission, by order, so
permits for the protection of security holders;
provided that applicable rules and regulations of
the Securities and Exchange Commission shall
govern as to whether the conditions described in
(2) and (3) exist.
We may defer the right of withdrawal from the
fixed Investment Accounts for not more than six
months from the day we receive written request and
the Contract, if required. If such payments are
deferred 10 days or more, the amount deferred will
earn interest at a rate not less than 3% per year.
TOTAL WITHDRAWAL Upon receipt of your request to withdraw the
entire Contract Value, we will terminate the
Contract and pay you the Contract Value, less any
applicable Debt, Withdrawal Charges and the Annual
Fee.
PARTIAL WITHDRAWAL If you are withdrawing part of the Contract Value,
you should specify the amount that should be
withdrawn from each Investment Option of the
Contract. If there are multiple Investment
Accounts under a fixed Investment Option, the
requested amount from that Investment Option must
be withdrawn from those Investment Accounts on
first-in-first-out basis. If you do not specify,
the requested amount will be withdrawn in the
following order:
a) Variable Investment Accounts, on a pro rata
basis,
b) Fixed Investment Options beginning with the
shortest guarantee period first and the
longest guarantee period last.
We will deduct the Withdrawal Charge, if
applicable, from the Contract Value remaining
after payment of the requested amount.
Partial withdrawals will reduce the Minimum Death
Benefit, as described on the Specifications Page.
VENTURE.100-NY-REV.06 [SAMPLE]
10.1
WITHDRAWAL CHARGE If a withdrawal is made from the Contract before
the Maturity Date, a Withdrawal Charge (contingent
deferred sales charge) may be assessed against
Payments. The amount of the Withdrawal Charge and
when it is assessed is discussed below:
1. The Free Withdrawal Amount is defined on the
Specifications Page.
The Free Withdrawal Amount may be withdrawn
free of a Withdrawal Charge.
The Free Withdrawal Amount will be applied to
your requested withdrawal in the following
order:
(a) withdrawals from the variable Investment
Accounts,
(b) withdrawals from the fixed Investment
Options beginning with the shortest
guarantee period first and the longest
guarantee period last.
2. If a withdrawal is made for an amount greater
than the Free Withdrawal Amount, Payments
will be liquidated on a first-in-first-out
basis. We will liquidate Payments in the
order such Payments were made: the oldest
unliquidated Payment first, the next Payment
second, etc. until all Payments have been
liquidated.
3. Any Payments liquidated may be subject to a
Withdrawal Charge based on the length of time
the Payment has been in the Contract. The
Withdrawal Charge is determined by
multiplying the amount of the Payment being
liquidated by the applicable Withdrawal
Charge Percentage obtained from the table
shown on the Specifications Page.
The total Withdrawal Charge will be the sum
of the Withdrawal Charges for the Payments
being liquidated.
4. The Withdrawal Charge is deducted from the
Contract Value remaining after you are paid
the amount requested, except in the case of a
complete withdrawal when it is deducted from
the amount otherwise payable. In the case of
a partial withdrawal, the amount requested
from an Investment Account may not exceed the
value of that Investment Account less any
applicable Withdrawal Charge.
FREQUENCY AND AMOUNT OF You may make as many partial withdrawals as you
PARTIAL WITHDRAWALS wish. Limitations on the amount of partial
withdrawals are set forth on the Specifications
Page.
VENTURE.100-NY-REV.06 [SAMPLE]
10.2
PART 11 FEES AND DEDUCTIONS
------- -------------------
ASSET FEE To compensate us for assuming mortality and
expense risks, and certain administration
expenses, we deduct from each variable Investment
Option a fee each Valuation Period at an annual
rate set forth on the Specifications Page. A
portion of this Asset Fee may also be used to
reimburse us for distribution expenses. This fee
is reflected in the Net Investment Factor used to
determine the value of Accumulation Units and
Annuity Units of the Contract.
ANNUAL FEE To compensate us for assuming certain
administrative expenses, we may charge an Annual
Fee if specified on the Specifications Page. The
Annual Fee deducted from the Fixed Investment
Accounts will not exceed $30. Prior to the
Maturity Date, the Annual Fee is deducted on each
Contract Anniversary. It is withdrawn from each
Investment Option in the same proportion that the
value of the Investment Accounts of each
Investment Option bears to the Contract Value. If
the Contract Value is totally withdrawn on any
date other than the Contract Anniversary, we
will deduct the total amount of the Annual Fee
from the amount paid. After the Maturity Date, the
Annual Fee is deducted on a pro rata basis from
each annuity payment. However, the Annual Fee will
not reduce the annuity payments below the amount
that would result from the application of the
annuity payment rates stated in Part 13, Payment
of Contract Benefits.
TAXES We reserve the right to charge certain taxes
against your Payments (either at the time of
payment or liquidation), Contract Value, payment
of Death Benefit, or annuity payments, as
appropriate. Such taxes may include premium taxes
or other taxes levied by any government entity
which we, in our sole discretion, determine have
resulted from the establishment or maintenance of
the Variable Account, or from the receipt by us of
Payments, or from the issuance of this Contract,
or from the commencement or continuance of annuity
payments under this Contract.
VENTURE.100-NY-REV.06 [SAMPLE]
11.1
PART 12 LOAN PROVISIONS (CERTAIN QUALIFIED CONTRACTS ONLY)
------- --------------------------------------------------
GENERAL This loan provision applies only to certain
Qualified Contracts. All provisions and terms of a
loan are included in the Qualified Plan
Endorsement, if attached.
VENTURE.100-NY-REV.06 [SAMPLE]
12.1
PART 13 PAYMENT OF CONTRACT BENEFITS
------- ----------------------------
GENERAL Benefits payable under this Contract may be
applied in accordance with one or more of the
Annuity Options described below, subject to any
restrictions of Internal Revenue Code section
72(s). Once annuity payments commence, the Annuity
Option may not be changed. The "Life 10-year
certain" Annuity Option described under part b) of
Options 1 and 2 below will be the default Annuity
Option, unless you request another, any time on or
before the Maturity Date.
ALTERNATE ANNUITY OPTIONS Instead of settlement in accordance with the
Annuity Options described below, you may choose an
alternate form of settlement acceptable to us.
Once annuity payments commence, the form of
settlement may not be changed.
DESCRIPTION OF ANNUITY Option 1: Life Annuity
OPTIONS
a) Life Non-Refund. We will make payments during
the lifetime of the Annuitant. No payments
are due after the death of the Annuitant.
b) Life 10-Year Certain. We will make payments
for 10 years and after that during the
lifetime of the Annuitant. No payments are
due after the death of the Annuitant or, if
later, the end of the 10-year period.
Option 2: Joint and Survivor Life Annuity
The second Annuitant named shall be referred to as
the Co-Annuitant.
a) Joint and Survivor Non-Refund. We will make
payments during the joint lifetime of the
Annuitant and Co-Annuitant. Payments will
then continue during the remaining lifetime
of the survivor. No payments are due after
the death of the last survivor of the
Annuitant and Co-Annuitant.
b) Joint and Survivor with 10-Year Certain. We
will make payments for 10 years and after
that during the joint lifetime of the
Annuitant and Co-Annuitant. Payments will
then continue during the remaining lifetime
of the survivor. No payments are due after
the death of the survivor of the Annuitant
and Co-Annuitant or, if later, the end of the
10-year period.
VENTURE.100-NY-REV.06 [SAMPLE]
13.1
TABLE OF ANNUITY PAYMENT RATES
ANNUITY PAYMENT RATES The annuity payment rates on the attached tables
show, for each $1,000 applied, the dollar amount
of both: (a) the first monthly variable annuity
payment based on the assumed interest rate of 3%
per year; and (b) the monthly fixed annuity
payment, when this payment is based on the minimum
guaranteed interest rate of 3% per year. The
annuity payment rates for payments made on a less
frequent basis (quarterly, semiannual or annual)
will be quoted by us upon request.
The annuity payment rates are based on the 1983
Table A projected at Scale G with interest at the
rate of 3% per year, and assume births in the year
1942. The amount of each annuity payment will
depend upon the sex and adjusted age of the
Annuitant, the Co-Annuitant, if any, or other
payee. The actual age is determined based on the
actual age nearest birthday at the time the first
monthly annuity payment is due. The adjusted age
is determined by adjusting the actual age in
accordance with the following table:
Calendar Year of Birth Adjustment to Actual Age
---------------------- ------------------------
1899 - 1905 +6
1906 - 1911 +5
1912 - 1918 +4
1919 - 1925 +3
1926 - 1932 +2
1933 - 1938 +1
1939 - 1945 0
1946 - 1951 -1
1952 - 1958 -2
1959 - 1965 -3
1966 - 1972 -4
1973 - 1979 -5
1980 - 1986 -6
1987 - 1993 -7
1994 + -8
The dollar amount of annuity payment for any age
or combination of ages not shown following or for
any other form of Annuity Option agreed to by us
will be quoted on request.
VENTURE.100-NY-REV.06 [SAMPLE]
T.1
AMOUNT OF FIRST MONTHLY PAYMENT
PER $1000 OF CONTRACT VALUE
OPTION 1: LIFE ANNUITY
Option 1(A): Non-Refund
Adjusted Age
of Annuitant Male Female
------------ ----- ------
55 4.27 3.86
60 4.69 4.19
65 5.25 4.61
70 6.02 5.19
75 7.01 5.99
80 8.34 7.10
85 10.13 8.64
Option 1(B): 10-Year Certain
Adjusted Age
of Annuitant Male Female
------------ ----- ------
55 4.22 3.84
60 4.61 4.15
65 5.10 4.55
70 5.71 5.07
75 6.42 5.73
80 7.20 6.52
85 7.97 7.37
OPTION 2: JOINT AND SURVIVOR LIFE ANNUITY
Option 2(A): Non-Refund
Age of Co-Annuitant
------------------------------------------------------------
Adjusted
Age of Male 10 Years 5 Years Same 5 Years 10 Years
Annuitant Younger Younger Age Older Older
----------- -------- ------- ---- ------- --------
55 3.25 3.39 3.55 3.72 3.87
60 3.41 3.60 3.81 4.02 4.21
65 3.62 3.87 4.14 4.41 4.67
70 3.89 4.21 4.57 4.95 5.29
75 4.24 4.67 5.17 5.67 6.11
80 4.71 5.30 5.97 6.63 7.19
85 5.35 6.15 7.05 7.92 8.60
Option 2(B): 10 Year Certain
Age of Co-Annuitant
------------------------------------------------------------
Adjusted
Age of Male 10 Years 5 Years Same 5 Years 10 Years
Annuitant Younger Younger Age Older Older
----------- -------- ------- ---- ------- --------
55 3.25 3.39 3.55 3.72 3.87
60 3.41 3.60 3.80 4.01 4.21
65 3.62 3.86 4.13 4.41 4.66
70 3.89 4.21 4.56 4.92 5.24
75 4.24 4.66 5.13 5.58 5.95
80 4.69 5.25 5.85 6.39 6.78
85 5.28 6.00 6.71 7.27 7.67
Monthly installments for ages not shown will be furnished on request.
VENTURE.100-NY-REV.06 [SAMPLE]
T.2
XXXX XXXXXXX LIFE INSURANCE (JOHNHANCOCK (R) LOGO)
COMPANY OF NEW YORK
